Jaundice may be the only clinical manifestation of primary hepatosplenic diffuse large B-cell lymphoma: a case report and literature review

Primary hepatic lymphoma a case report and literature review

RATIONALE

Primary hepatic lymphoma is a rare extranodal non-Hodgkin lymphoma that is primarily localized in the liver. It predominantly affects elderly males and presents with nonspecific laboratory findings, imaging results, and clinical symptoms, making diagnosis challenging. Histopathological examination serves as the gold standard for diagnosis, and treatment options include chemotherapy or surgical intervention combined with chemotherapy.

PATIENT CONCERNS

A 50-year-old male patient came to our hospital for treatment after finding a mass in his liver.

DIAGNOSES

Laboratory tests and clinical symptoms lack specificity for primary hepatic lymphoma, and imaging findings can be difficult to differentiate. Pathology is the gold standard.

OUTCOMES

The patient was dead.

CONCLUSION

A definitive diagnosis primarily relies on histopathological examination, and surgical resection combined with chemotherapy yields better treatment outcomes.

B-cell hepatosplenic lymphoma presenting in adult patient after spontaneous splenic rupture followed by severe persistent hypoglycaemia: type B lactic acidosis and acute liver failure

A patient was admitted to hospital with splenic rupture, four 4 days after colonoscopy was performed following one month's intermittent and aggravating abdominal pain. During recovery from splenectomy, the patient developed sudden tachycardic and tachypnoea. A blood sample revealed a very low blood glucose, high lactate and acidaemia.The patient required high-dose continuous intravenous glucose, while the lactate remained elevated. Decreasing consciousness with signs of acute liver failure necessitated transfer to an advanced intensive care unit. The patient's clinical status rapidly deteriorated despite therapeutic intervention. The patient died of multiorgan failure eleven days post-splenectomy. Based on the pathology of the spleen and a post-mortem liver specimen, the patient was diagnosed with a primary extra-nodal B-cell hepatosplenic lymphoma (BCHSL) - an extremely rare form of non-Hodgkin lymphomanon.Splenic rupture followed by lactic acidosis and hypoglycaemia should lead to suspicion of a cancer-mediated Warburg effect, and prompt urgent chemotherapy.

Diffuse large B-cell lymphoma presenting as reversible intrapulmonary arteriovenous shunts with hypoxia, fever and progressive jaundice: a case report and literature review

Background

Intrapulmonary arteriovenous shunts is rare seen in a patient without lung involvement.

Case presentation

This is the first report of reversible intrapulmonary arteriovenous shunts secondary to extrapulmonary lymphoma as one initial symptom. The patient presented as fever of unknown origin and dyspnea, and examinations of infection were negative. Diagnosis of DLBCL was finally confirmed through bone marrow and splenic biopsies. Intrapulmonary arteriovenous shunts were diagnosed through 100% oxygen inhalation test and transthoracic contrast echocardiography (TTCE). After the treatment of lymphoma, his respiratory failure was relieved. We rechecked the 100% oxygen inhalation test and TTCE, which both indicated that his intrapulmonary arteriovenous shunts had resolved.

Conclusions

We speculated the prominent inflammation from active DLBCL was the most possible mechanism associated with the reversible intrapulmonary shunt in this patient. These findings will assist us to better understand the mechanism of intrapulmonary shunts.